Targeted Program Curbs Teen Drinking

Action Points

This is a report of 24-month outcomes of a randomized trial in which school staff were trained to provide interventions to adolescent students, targeting youth at high risk of addiction and mental health problems.

The investigators found long-term beneficial effects of the intervention on drinking rates and binge drinking rates for high-risk youth, as well as some mild herd effects.

In a randomized controlled trial, the targeted program reduced the risk of binge drinking by 43% (OR 0.57, 95% CI 0.41 to 0.80, P<0.001), Patricia Conrod, PhD, of the University of Montreal, and colleagues reported online in JAMA Psychiatry.

It also appeared to have a "herd" effect on adolescents who weren't considered to be at risk for problematic drinking, the researchers said.

"Considering the enormous costs of alcohol misuse to society and the brief and inexpensive nature of this targeted program, nationwide implementation could potentially translate to substantial savings to the public," they wrote.

Some prevention programs that target kids with personality risk factors for addiction and mental health problems have been shown to reduce substance use and misuse.

To further evaluate that relationship, Conrod and colleagues conducted the Teacher-Delivered Personality-Targeted Interventions for Substance Misuse (known as the Adventure trial) at 21 secondary schools in London boroughs totaling 2,643 students -- 1,210 of whom were considered to be at high risk for drinking problems. Their mean age was 13.7.

Schools were randomized to provide either a brief personality-targeted intervention to high-risk youth or to provide treatment as usual.

In the personality intervention, school staff -- including teachers, counsellors, and education specialists -- were trained to provide interventions to students with one of four high-risk profiles: anxiety sensitivity, hopelessness, impulsivity, and sensation seeking.

Training involved a 2- to 3-day workshop in which staff learned how to administer to cognitive behavioral therapy (CBT) principles and motivational enhance therapy (MET) in personality-specific ways.

The students were then assessed for drinking, binge drinking, and problem drinking at 6-month intervals for 2 years.

Conrod and colleagues found that overall, high-risk students at intervention schools had a 29% lower risk of drinking over the course of the trial compared with high-risk kids at control schools (OR 0.71, 95% CI 0.51 to 0.99, P=0.046).

They also had a 43% lower likelihood of binge drinking during the trial compared with high-risk controls (OR 0.57, 95% CI 0.41 to 0.80, P<0.001).

And the odds of problem drinking fell by 29% for high-risk kids at intervention schools compared with controls (OR 0.71, 95% CI 0.53 to 0.94, P=0.02).

But the "secondary outcomes of this trial are particularly novel" as well, the researchers wrote, noting that the intervention appeared to display a herd effect in kids who weren't perceived to be at high risk of problem drinking.

It appeared to delay the "natural progression to more risky drinking behavior," they said. For instance, the intervention significantly reduced overall drinking rates (P=0.049) and the growth in rates of binge drinking (P=0.001) over the course of the study in low-risk kids.

There were also "some signs of a marginal herd effect on problem drinking symptoms in the longer term," they wrote.

The potential mechanisms of this herd effect aren't clear, the researchers wrote, but said it may be that high-risk kids at intervention schools "modeled less drinking and less problematic drinking to their low-risk peers, who have a later onset of drinking and a less risky drinking profile."

That hypothesis is supported by the fact that the intervention effects on binge drinking and problematic drinking in low-risk kids started to appear 6 months after intervention effects on high-risk students, they noted.

The study was limited by its reliance on self-reported data from students, but Conrod and colleagues still concluded that broader models of the intervention should be assessed.

The study was supported by the charity Action on Addiction.

The researchers reported no relevant financial conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.